Issues for Integrative Medicine. Ian D. Coulter Ph.D. School of Dentistry, UCLA; RAND; Southern California University of Health Sciences; La Trobe University

When I use a word,” Humpty Dumpty said, in rather scornful tone, “it means just what I chose it to mean-neither more nor less.” “The question is, said Alice, “whether you can make words mean so many different things.” Through the Looking Glass, Lewis Carroll. Meaning All You Can Mean

Integrative Medicine “Problematised” 1. Meaning integrated vs integrative (US vs GB) 2. Integrating CAM into mainstream medicine 3. Basis for integration Financial Therapeutic EBP-epistemological claim Reputational Historical Provider based Patient based Philosophically based 4. Type of integration dominating vs transformative (Kailin 2001) 5. Heterogeneity of CAM

The Two Solitudes “ It is time for the scientific community to stop giving alternative medicine a free ride. There cannot be two kinds of medicine… There is only medicine that has been adequately tested and medicine that has not, medicine that works…” Angell, Kassirer “ It mightn’t be too pretentious (although it might) to say that such a growth might restore the soul to medicine” Smith 2001

Two Paradigms These are two distinct constructions of reality, different & opposing views about illness, health, health care & healing. They are alternative philosophical paradigms.

Naming the Paradigms  Conventional vs. Unconventional  Orthodox vs. Unorthodox  Mainstream vs. Marginal  Medical vs. Non-medical  Alternative vs. Complementary  Integrative vs Non-Integrative?

Naming the Paradigms Generic terms:  Medicine  Physician Co-opting of the terms by mainstream medicine so that medicine means their medicine, physician means only their physicians.

Naming the Paradigms Specific Paradigms:  Homeopathic Medicine, Chiropractic Medicine, Naturopathic Medicine, Traditional Chinese Medicine, Ayuverdic Medicine, Allopathic Medicine (Bio-medicine) Specific Physicians:  Homeopathic Physician, Chiropractic Physician, Naturopathic Physician, TC Physician, Ayuverdic Physician, Allopathic Physician

The “Medical” Paradigm  Germ theory  Science transformation  Wonder drugs  Flexner report  Academic medicine  The teaching hospital  Reductionism  External causes  Materialism  Biological determinism  Dualism  Structural functionalist

The Philosophy of Health & Health Care in “Medicine”  Health equals the absence of disease  Illness equals disease equals disordered pathology or trauma  The objective of treatment is cure  The role of the provider is to cure the patient  Science is the way of knowing  Philosophy, critical rationalism

The CAM Paradigm  Reaction to the germ theory  Distribution of disease  Lost sight of the person  Focus on symptoms not causes Alternative view  Internal causes  Health comes from within  Predisposing factors  Treat causes not symptoms  Treat the whole person

The Metaphysics of CAM  Vitalism/spiritualism- the healing power of nature, Taoist, Hindu, Buddhist, Theosophy, Metaphysics  Holism- mind, body, & spirit, non-reductionist  Naturalism- the body is built on nature’s order, we should look to nature for the cure  Humanism-immutable rights, right to dignity, cooperative care, individuality  Conservatism- the least care is the best care, the body heals itself

The Philosophy of Health & Health Care in CAM  Health is the natural state, the innate tendency of the body is to restore health, homeostasis  Health is the expression of body, mind and spirit  Health is unique for each person  Health comes from within  Disease vs illness (dis-ease)  Health is not just the absence of disease  Treatment is not equal to care  Treat the whole person  The healer is a facilitator and an educator- “I can no more give you health than I can give you honesty”

Can They Be Integrated? Systems Theory Embraces several features that make it an ideal candidate in its approach to biological/psychological/ social systems  The whole cannot be reduced to its parts  Contexts alter elements  Ecological view of the organism/environment  Synchronicity of elements  The body is a multileveled structure, interrelated, interdependent and complex  Interactive feedback and non- linear causality  Principle of self organization  Natural return to a balanced state- homeostasis  Capacity to create new structures-emergent properties  Mind has the same systemic properties as life itself  Mind as organizing process

Conclusion “ The question is, “ said Humpty Dumpty, “which is to be master-that’s all-however I can manage the whole lot of them! Impenetrability! That’s what I say.” “Would you tell me, please,” said Alice, “what that means.” “ Now you talk like a reasonable child”..”I meant by impenetrability that we’ve had enough of that subject and it would be just as well if you’d mention what you mean to do next, as I suppose you don’t mean to stop here all the rest of your life.” Through the Looking Glass.

Ian Coulter. “Integration and Paradigm Clash” in Tovey P, Easthope G, Adams J (eds). The Mainstreaming of Complementary and Alternative Medicine. Studies in the Social Context. London, Routledge, 2004.